Does balanced haemostasis equate to normal coagulation in patients with acute liver failure?

Abstract

Patients with liver disease whether acute or chronic suffer from a coagulopathy and this, in the past, has been associated with a bleeding phenotype. Laboratory investigations typically reveal a high Prothrombin Time (PT)/International Normalized Ratio (INR) and Activated Partial Thromboplastin Time (APTT) and sometimes a low fibrinogen level. The high PT was noted since the inception of the test by Armand Quick (1). It was later realized that this test was exquisitely sensitive to low factor VII levels. The PT/INR became established tests to monitor coumarin anticoagulant therapy and as high PT/INR values correlate with an increased risk of bleeding in patients on similar drugs, the raised PT in patients with liver disease was considered to indicate a state of ‘autoanticoagulation’. This notion has been challenged over the past decade.